All pastes #48841 Raw Edit

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public text v1 · immutable
#48841 ·published 2006-04-10 06:13 UTC
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<form action='petition.php?s=done' method='post'>
				<table border='0' align='center'>
					<tr>
						<td align='right'>First Name:</td> <td align='left'><input type='text' name='f'></td> <br>
					</tr>
					<tr>
						<td align='right'>Last Name:</td> <td align='left'><input type='text' name='l'></td> <br>
					</tr>
					<tr>
						<td align='right'>City:</td> <td align='left'><input type='text' name='c'></td> <br>
					</tr>
					<tr>
						<td align='right'>Province:</td> <td align='left'><input type='text' name='p'></td> <br>
					</tr>
					<tr>
						<td align='right'>Phone:</td> <td align='left'><input type='text' name='ph'></td> <br>
					</tr>
					<tr>
						<td align='right'>Email:</td> <td align='left'><input type='text' name='e'></td> <br><br>
					</tr>
					<tr>
						<td></td><td align='left'><input type='submit' name='go' value='Submit'></td>
					</tr>
				</table>
			</form>